ObjectiveThis pragmatic, randomized, non-inferiority trial compared the effectiveness and cost of group-based parent management training (PMT) versus mastery-based individual coaching PMT in a low-income, predominantly African American sample.MethodParents seeking treatment for their 2-5 year old children’s behavior problems in an urban fee-for-service child mental health clinic were randomized to the Chicago Parent Program (CPP; n=81) or Parent-Child Interaction Therapy (PCIT; n=80). Consent followed clinic intake and diagnostic assessment and PMT was delivered by clinicians employed at the clinic. Primary outcome measures were externalizing child behavior problems, assessed at baseline and post-intervention follow-up, using the Child Behavior Checklist (CBCL) and average per participant treatment cost.ResultsData from 158 parents were analyzed. Most were mothers (75.9%), African American (70.3%), and economically disadvantaged (98.7% Medicaid insured). Among the children, 58.2% were boys, mean age (SD) was 3.6 years (1.03). Based on CBCL scores, behavior problems improved in both conditions (Cohen’s d=0.57 for CPP and 0.50 for PCIT). CPP was not inferior to PCIT (90% CI -1.58, 4.22) at follow-up, even after controlling for differences in treatment length (90% CI -1.63, 4.87). Average per participant treatment cost was higher for PCIT (M=$2,151) than CPP (M=$1,413) (95% CI $-1,304, $-170).ConclusionsAmong parents of young children living in urban poverty, CPP is not inferior to PCIT for reducing child behavior problems. CPP requires less time to complete and costs a third less than PCIT.

Objective
Although poor sleep is often reported in adolescents with attention-deficit/hyperactivity disorder (ADHD), prior studies have been correlational. This study investigated whether sleep duration is causally linked to sleepiness, inattention, and behavioral functioning in adolescents with ADHD.
Method
Seventy-two adolescents (ages 14-17 years) entered a three-week sleep protocol using an experimental crossover design. The protocol included a phase stabilization week, followed in randomized counterbalanced order by 1 week of sleep restriction (6.5 hours) and 1 week of sleep extension (9.5 hours). Sleep was monitored with actigraphy and daily sleep diaries, with laboratory visits at the end of each week. Analyses included 48 adolescents who had complete actigraphy data and successfully completed the sleep protocol (defined a priori as obtaining ≥1 hour actigraphy-measured sleep duration during extension compared to restriction). Parent and adolescent ratings of daytime sleepiness, ADHD symptoms, sluggish cognitive tempo (SCT), and oppositional behaviors were the primary measures. The A-X Continuous Performance Test (CPT) was a secondary measure.
Results
Compared to the extended sleep week, parents reported more inattentive and oppositional symptoms during the restricted sleep week. Both parents and adolescents reported more SCT symptoms and greater daytime sleepiness during restriction compared to extension. Adolescents reported less hyperactivity-impulsivity during sleep restriction than extension. No effects were found for parent-reported hyperactivity-impulsivity, adolescent-reported ADHD inattention, or CPT performance.
Conclusion
This study provides the first evidence that sleep duration is a causal contributor to daytime behaviors in adolescents with ADHD. Sleep may be an important target for intervention in adolescents with ADHD.

Objective
To compare the prevalence and risk factors associated with Psychotic-Like-Experiences (PLE) in offspring of parents with bipolar disorder (BP) and offspring of community control parents.
Method
Delusional and hallucinatory subclinical psychotic experiences were evaluated at intake and longitudinally in a cohort study of 390 offspring of BP parents and 247 offspring of control parents aged 6-18 years old. The sample was followed up every 2.5 years on average for 8.3 years. 91.7% of the sample completed at least one follow up. Risk factors at intake and at each assessment until the onset of PLE were analyzed using survival models.
Results
95 (14.9%) offspring reported PLE at some point of the study, 16.9% of BP parents and 11.7% of controls, without statistically significant differences. Psychotic disorders were less frequent, 16 (2.5%) in both groups. During follow-up, three variables remained as the most significant associated with PLE in the multivariate models: 1) presence of any psychiatric disorder (HR = 3.1; p = .01); 2) low psychosocial functioning (HR = 2.94; p < .0001); and 3) current or past history of physical or sexual abuse (HR = 1.85; p = .04). There were no effects of any subtype of BP, IQ, history of medical illnesses, exposure to medications, or perinatal complications.
Conclusion
In line with previous studies, PLE in our sample were relatively common, and were associated with higher morbidity during the follow-up. Contrary to the literature, neither family risk for bipolar nor early neurodevelopmental insults were associated with PLE.

Objective
We conducted meta-analyses to assess risk of anxiety disorders among offspring of parents with anxiety disorders and to establish whether there is evidence of specificity of risk for anxiety disorders as opposed to depression in offspring, and whether particular parent anxiety disorders confer risks for particular child anxiety disorders. We also examined whether risk was moderated by offspring age, gender, temperament and the presence of depressive disorders in parents.
Method
We searched PsycINFO, PubMed and Web of Science in June, 2016 and July, 2017 (PROSPERO CRD42016048814). Study inclusion criteria: published in peer-reviewed journals; contained at least one group of parents with anxiety disorders and at least one comparison group of parents who did not have anxiety disorders; reported rates of anxiety disorders in offspring, and used validated diagnostic tools to ascertain diagnoses. We used random and mixed-effects models and evaluated study quality.
Results
We included 25 studies (7285 offspring). Where parents had an anxiety disorder, offspring were significantly more likely to have anxiety (RR: 1.76, 95% CI = 1.58-1.96) and depressive disorders (RR: 1.31, 95% CI = 1.13-1.52) than offspring of parents without anxiety disorders. Parent Panic Disorder and Generalized Anxiety Disorder appeared to confer particular risk. Risk was greater for offspring anxiety than depressive disorders (RR: 2.50, 95% CI = 1.50-4.16), and specifically for offspring Generalized Anxiety Disorder, Separation Anxiety Disorder and Specific Phobia, but there was no evidence that children of parents with particular anxiety disorders were at increased risk for the same particular anxiety disorders. Moderation analyses were possible only for offspring age, gender and parental depressive disorder; none were significant.
Conclusion
Parent anxiety disorders pose specific risks of anxiety disorders to offspring. However, there is limited support for transmission of the same particular anxiety disorder. These results support the potential for targeted prevention of anxiety disorders.

Objective
Recent attention to pervasive sleep deficits in U.S. adolescents has focused on sleep patterns and insomnia, but there are limited data on the prevalence and correlates of hypersomnolence symptoms.
Method
The sample included 6,483 adolescents ages 13-18 years who were interviewed directly and had parent reports in the National Comorbidity Survey Replication Adolescent Supplement (NCS-A), a nationally representative sample of US youth. Information on sleep patterns/symptoms that were collected in the interview was used to determine the population prevalence of DSM-5 criterion-A defined hypersomnolence and component symptoms. Logistic regression analyses were used to examine associations between sleepiness and sub-symptoms of hypersomnolence with weekday/weekend bedtime, sleep duration, mental disorders and psychotropic medication use.
Results
41.5% of US adolescents reported feeling sleepy during the daytime and 11.7% met criteria for hypersomnolence. The prevalence of hypersomnolence varied depending on age (p<0.001) and was more common in adolescent girls (OR=1.40; 95% CI=1.09-1.78). Excessive sleepiness and hypersomnolence symptoms were associated with reduced sleep duration and delayed bedtimes on weekdays and weekends Hypersomnolence was significantly associated with insomnia (OR=2.45; 95% CI=1.87-3.21) and mental disorders (OR=1.99; 95% CI=1.42-2.77). After accounting for insomnia, hypersomnolence was no longer associated with use of psychotropic medication (OR=1.61; CI=0.97-2.66).
Conclusion
Among adolescents with adequate sleep duration, we found that 11.7% still report symptoms of hypersomnolence. The strong association between hypersomnolence with insomnia suggests that sleep disorders in adolescents may fluctuate between over- and under-sleeping. Potential mechanisms underpinning the strong associations between sleep disturbances and mental disorders should be further pursued and may provide insight into prevention efforts.

Objective
Adolescent controlled prescription drug misuse (PDM) co-occurs with significant consequences, including lower educational achievement, substance use disorder (SUD) symptoms, and psychopathology. Nonetheless, adolescent PDM sources and the prevalence of other substance use, SUD and mental health outcomes associated with sources remain poorly understood.
Method
Data were from the 2009-2014 National Survey on Drug Use and Health, including 103,920 adolescents (12-17 years). Six mutually exclusive sources were used: physician source only, theft/fake prescription only, friend/relative for free only, purchases only, other source only, or multiple sources. Analyses occurred separately for prescription opioids, stimulants and tranquilizer/sedatives. PDM source prevalence across adolescents and by sex and school enrollment/engagement were estimated. Adjusted odds of past-year DSM-IV substance-specific SUD, marijuana use, any SUD, major depression (MDD), anxiety diagnosis and mental health treatment and past-month binge drinking were estimated by source.
Results
Friends/relatives for free was the most common source (29.0%-33.2%), followed by physician sources for opioids (23.9%) and purchases for stimulants (23.5%) and tranquilizer/sedatives (22.7%). Few school enrollment/engagement differences existed, but females were more likely to use multiple sources. Over 70% of adolescents using multiple sources had a past-year SUD. Multiple sources, purchases, and theft/fake prescription were more strongly associated with other substance use than physician source use, and multiple source use was linked with MDD.
Conclusion
Adolescents using multiple sources, purchases and theft/fake prescriptions have elevated rates of other substance use, SUD and MDD and particularly warrant intervention. Also, adolescents with other SUD and MDD should be screened for PDM and misuse sources.

Objective
Foundational knowledge on neural circuitry underlying pediatric obsessive-compulsive disorder (OCD) and how it changes during standard treatment is needed to provide the basis for conceptualization and development of novel, targeted treatments. This study explored the effects of sertraline, a selective serotonin reuptake inhibitor, on resting-state functional connectivity (RSFC) in cortico-striatal-thalamic-cortical circuits in pediatric OCD.
Method
Medication-free youths with OCD (n=14) and healthy controls (n=14) were examined at baseline and 12 weeks with resting-state fMRI. Between scan sessions, participants with OCD received 12 weeks of sertraline. For each scan, we conducted seed-based whole-brain RSFC analyses with 6 striatal seeds. Analysis of variance (ANOVA) examined the interaction between group and time on striatal connectivity, including cluster-based thresholding to correct for multiple tests. Connectivity changes within circuits identified in group analyses were correlated with clinical change.
Results
Two significant group x time effects in the OCD group showed increased striatal connectivity from baseline to 12 weeks compared with controls. Circuits demonstrating this pattern included right putamen with left frontal cortex/insula and left putamen with left frontal cortex and pre- and post-central cortices. Increase in connectivity in left putamen circuit was significantly correlated with clinical improvement on Children’s Yale-Brown Obsessive-Compulsive Scale (r = -0.58, p = .03).
Conclusion
Sertraline appears to affect specific striatal-based circuits in pediatric OCD, and in part, these changes may account for clinical improvement. Future work is needed to confirm these preliminary findings, which would facilitate identification of circuit-based targets for novel treatment development.

Objective
To expand knowledge of co-occurring alcohol use and disordered eating behaviors (DEB) among sexual minority (ie, nonheterosexual) youth.
Method
Using pooled 2009-2015 US Youth Risk Behavior Surveys (322,687 students; 7.3% lesbian, gay, bisexual), multivariable logistic regression models examined: (1) associations of age of onset of drinking and past month binge drinking with past year DEB (fasting, diet pill use, purging, steroid use); and (2) effect modification by sexual orientation.
Results
Alcohol use and sexual minority identity were independently associated with elevated odds for diet pill use and purging among females, and fasting and steroid use among males. Odds of fasting increased with greater frequency of monthly binge drinking among heterosexual adolescent females, and odds of diet pill use increased with greater frequency of monthly binge drinking among heterosexual adolescent males. DEB prevalence was particularly pronounced among adolescents who binge drank and who were not sure of their sexual orientation identity. Among males not sure of their sexual orientation identity, those who binge drank more than one day in the past month had 8.63-23.62 times the odds of using diet pills relative to those who did not binge drink, and 13.37-26.42 times the odds of purging relative to those who did not binge drink.
Conclusion
More research is needed on psychosocial factors underlying alcohol use and DEB in youth of all sexual orientations.

Objective
High co-occurrence of externalizing and internalizing problems may underlie inconsistent findings regarding the relation between heart rate and psychopathology. In this study, heart rate measures are examined in relation to a general dysregulation profile, studied from both a variable- and person-centered approach.
Method
The sample (N = 182) consisted of 8-12-year-old children referred for externalizing behaviors and typically-developing children (Mage = 9.70, SD = 1.26, 75.8% boys). Resting heart rate (HRrest) was assessed during a 3-minute resting period. Heart rate reactivity (HRreactivity) was assessed during an emotionally evoking Go/No-Go task.
Results
From a variable-centered approach, a bifactor model was fitted with a general factor of dysregulation underlying symptoms of anxiety/depression, aggression and attention problems.
HRrest was positively associated with dysregulation and specific aggression. From a person-centered approach, a latent profile analysis was used to identify different psychopathology classes: normative (n = 92), predominantly-aggressive (n = 69) and dysregulated (n = 14). The latter was characterized by co-occurring elevated levels of anxiety/depression, aggression and attention problems. HRrest was elevated in the predominantly-aggressive class and HRreactivity was elevated in the dysregulated class.
Conclusions
High HRrest, or (trait-like) overarousal seems to be associated with dysregulation rather than uniquely with low externalizing or high internalizing symptomatology. Additionally, HRrest predicted higher aggression and HRrest was elevated in the predominantly-aggressive class. High HRreactivity, or enhanced emotional reactivity, might be characteristic for a clinically relevant dysregulated subgroup. Assessment of heart rate could provide additional knowledge on individual differences that can help refine diagnostics and intervention efforts.

Objective
Disturbances in self-regulatory control are involved in the initiation and maintenance of addiction, including cannabis use disorder (CUD). In adults, chronic cannabis use is associated with disturbances in fronto-striatal circuits during tasks that require the engagement of self-regulatory control, including the resolution of cognitive conflict. Understudied are the behavioral and neural correlates of these processes earlier in the course of cannabis use, disentangled from effects of long-term use. The present study investigates the functioning of fronto-striatal circuits during the resolution of cognitive conflict in cannabis-using youth.
Method
Functional magnetic resonance imaging data was acquired from 28 cannabis-using (CU) youth and 32 age-matched healthy participants (HC) during the performance of a Simon task. General linear modeling was used to compare patterns of brain activation during correct responses to conflict stimuli across groups. Psychophysiological interaction analyses were used to examine conflict-related fronto-striatal connectivity across groups. Associations of fronto-striatal activation and connectivity with cannabis use measures were explored.
Results
Reduced conflict-related activity was detected in CU relative to HC youth in fronto-striatal regions, including ventromedial prefrontal cortex (vmPFC), striatum, pallidum and thalamus. Fronto-striatal connectivity did not differ across groups, but negative connectivity between vmPFC and striatum was detected in both groups.
Conclusion
These findings are consistent with previous reports of cannabis-associated disturbances in fronto-striatal circuits in adults and point to the specific influence of cannabis on neurodevelopmental changes in youth. Future studies should examine whether fronto-striatal functioning is a reliable marker of CUD severity and potential target for circuit-based interventions.

Objective
Experiencing depression in adolescence can disrupt important developmental processes, which can have long-standing impacts on socioeconomic status and relationships. The objective of this paper was to systematically review the evidence examining associations between adolescent depression and adult psychosocial outcomes.
Method
Five databases (MEDLINE, Embase, PsycINFO, CINAHL, and ERIC) were searched for articles published between 1980 and March 2017. Eligible articles were peer-reviewed, published in English, had prospective cohort study designs, and contrasted adult psychosocial outcomes between those with and without adolescent depression. Outcomes with sufficient data were pooled using random effects meta-analyses, with summary measures reported as odds ratios. A protocol for this review was registered on PROSPERO (CRD42017059662).
Results
Of the 4,988 references screened for inclusion, 31 articles comprising 136 analyses were included for review. 24 cohorts were represented. 77 analyses across ten outcomes were meta-analyzed, with remaining analyses summarized narratively. Meta-analyses suggested that adolescent depression was associated with outcomes including, but not limited to, failure to complete secondary school (odds ratio [OR] = 1.76, 95% CIs 1.29- 2.39); unemployment (OR=1.66, 1.29-2.14); and pregnancy/parenthood (OR=1.38, 1.06-1.81).
Conclusion
This review demonstrates that adolescent depression is associated with a myriad of adult psychosocial outcomes. Many are linked and can lead to the propagation of difficulties across the lifespan. These findings can have important implications for encouraging the provision of targeted mental health care early in development to improve life chances.

Objective
Measurement of treatment outcomes in childhood depression has traditionally focused on assessing symptoms from the clinician’s perspective, without exploring other outcome domains or considering young people’s perspectives. This systematic review explored the extent to which multidimensional and multi-informant outcome measurement have been used in clinical research for adolescent depression in the past decade, and how patterns evolved over time.
Method
We searched Embase, MEDLINE and PsycINFO, and included studies published between 2007 and 2017 that assessed the effectiveness of treatments or service provision for adolescent depression. Of 7483 studies screened, 95 met inclusion criteria and were included for data extraction and analysis.
Results
We identified ten outcomes domains, of which studies assessed two on average, using four outcome measures. Most studies (94%) measured symptoms, followed by functioning (52%). Other domains such as personal growth, relationships, quality of life, or service satisfaction were each considered by less than one in ten studies. Youth self-report was considered by 54% but tended to focus on secondary outcomes. Multidimensional and multi-informant measurement has been more frequent in studies published since 2015.
Conclusion
Recent clinical research continues to prioritize symptoms measurement based on clinician report and has not yet fully embraced multi-dimensional and multi-informant approaches. In the context of significant policy shifts towards patient-centered and evidence-based care, measuring what matters most to patients has become a priority, but this is not yet widely reflected in clinical research.

Objective
The two primary – seemingly contradictory – strategies for classifying child psychiatric syndromes are categorical and dimensional; conceptual ambiguities appear to be greatest for polythetic syndromes such as autism spectrum disorder (ASD). Recently, a compelling alternative has emerged that integrates both categorical and dimensional approaches (ie, hybrid model) thanks to the increasing sophistication of analytic procedures. This study aimed to quantify the optimal phenotypic structure of ASD by comprehensively comparing categorical, dimensional, and hybrid models.
Method
The sample comprised 3,825 youth, who were consecutive referrals to a university developmental disabilities or child psychiatric outpatient clinic. Caregivers completed the Child and Adolescent Symptom Inventory-4R (CASI-4R), which includes an ASD symptom rating scale. A series of latent class analyses, exploratory and confirmatory factor analyses, and factor mixture analyses was conducted. Replication analyses were conducted in an independent sample (N=2,503) of children referred for outpatient evaluation.
Results
Based on comparison of 44 different models, results indicated that the ASD symptom phenotype is best conceptualized as multi-dimensional versus a categorical or categorical-dimensional hybrid construct. ASD symptoms were best characterized as falling along three dimensions (ie, social interaction, communication, and repetitive behavior) on the CASI-4R.
Conclusion
Findings reveal an optimal structure with which to characterize the ASD phenotype using a single, parent-report measure, supporting presence of multiple correlated symptom dimensions that traverse formal diagnostic boundaries and quantify the heterogeneity of ASD. These findings inform understanding of how neurodevelopmental disorders can extend beyond discrete categories of development and represent continuously-distributed traits across the range of human behaviors.

Objective
Bulimia nervosa (BN) is characterized by excessive attention to self and, specifically, body shape and weight, but the ventral attention (VAN) and default mode networks (DMN) that support attentional and self-referential processes are understudied in BN. We assessed whether altered functional connectivity within and between these networks contributes to such excessive concerns in adolescents with BN, early the course of the disorder.
Method
Resting-state functional magnetic resonance imaging scans were acquired from 33 BN and 37 healthy comparison (HC) adolescents (aged 12 to 21 years), group-matched by age and body mass index. Region-of-interest analyses were performed to examine group differences in functional connectivity within and between the VAN and DMN. We further explored associations of VAN-DMN connectivity with BN symptoms, body shape/weight concerns, and sustained attention on the Continuous Performance Test (CPT).
Results
Compared to HC adolescents, those with BN showed significantly increased positive connectivity between right ventral supramarginal gyrus and all DMN regions, as well as between right ventrolateral prefrontal cortex and left lateral parietal cortex. Within-network connectivity did not differ between groups. VAN-DMN connectivity was associated with BN severity and body shape/weight concerns in the BN group. No significant group-by-CPT interactions on VAN-DMN connectivity were detected.
Conclusion
Increased positive VAN-DMN connectivity in adolescents with BN may reflect abnormal engagement of VAN-mediated attentional processes at rest, perhaps related to their excessive attention to self-referential thoughts about body shape/weight. Future studies should further investigate these circuits as targets for the development of early interventions aimed at decreasing excessive body shape/weight concerns.

Objective
To evaluate the efficacy of Attachment-based Family Therapy (ABFT) compared to a Family Enhanced Non-Directive Supportive Therapy (FE-NST) for reducing adolescents’ suicide ideation and depressive symptoms.
Method
A randomized controlled trial of 129 suicidal adolescents, between the ages of 12 to 18 (49% were African-American) were randomized to ABFT (n = 66) or FE-NST (n = 63) for 16 weeks of treatment. Assessments occurred at baseline, 4, 8, 12, and 16 weeks. Trajectory of change and clinical recovery were calculated for suicidal ideation and depressive symptoms. Results: There was no significant between group difference in the rate of change in self-reported ideation Suicidal Ideation Questionnaire-Jr (SIQ-JR) (F(1,127) = 181, p=0.18). Similar results were found for depressive symptoms. However, adolescents receiving ABFT showed significant reduction in suicide ideation (t (127) = 12.61, p < .0001; effect size: d = 2.24). Adolescents receiving FE-NST experienced a similar significant reduction (t (127) = 10.88, p < .0001; effect size: d = 1.93). Response rates (i.e. 50% or more reduction in suicide ideation symptoms from baseline) at post-treatment were 69.1% for ABFT versus 62.3% for FE-NST.
Conclusion
Contrary to expectations, ABFT did not perform better than FE-NST. Both treatments produced substantial reductions in suicidal ideation and depressive symptoms that were comparable to or better than those reported in other more intensive, multicomponent treatments. The equivalent outcomes may be attributed to common treatment elements, different active mechanisms, or regression to the mean. Future studies will explore long-term follow up, secondary outcomes, and potential moderators and mediators.

Objective
Childhood irritability predicts suicidal ideation/attempt (suicidality), but it is unclear whether irritability is an independent and direct risk factor for suicidality, or a marker of intermediate mental health symptoms associated with suicidality. We aimed to (1) identify developmental patterns of childhood irritability; (2) test whether childhood irritability is directly associated with suicidality, or whether it is indirectly associated via intermediate mental health symptoms.
Method
N=1,393 participants from the Quebec Longitudinal Study of Child Development (QLSCD) were followed from birth to 17 years. Teachers assessed irritability yearly (6 to 12 years) and children self-reported intermediate mental health symptoms (depression, anxiety, disruptiveness, hyperactivity-impulsivity; 13 years), and suicidality (15 and 17 years).
Results
We identified 4 irritability trajectories: low (74.7%), rising (13.0%), declining (7.4%), persistent (5.0%). Children following a rising irritability trajectory (versus low trajectory) were at higher suicidality risk. A large proportion of this association was direct (OR=2.11, 95%CI=1.30-3.43) and a small proportion was indirect, via depressive symptoms (accounting for 23% of the association; OR=1.17, 95%CI=1.03-1.34). Children on a persistent irritability trajectory (versus low trajectory) were at higher risk of suicidality and this association was uniquely indirect, via depressive symptoms (accounting for 73% of the association; OR=1.51, 95%CI=1.16-1.97). The declining trajectory was not related to suicidality; no association via anxiety, disruptiveness and hyperactivity-impulsivity was found.
Conclusion
Rising irritability across childhood represents a direct risk for suicidality. Persistent irritability appears to be a distal marker of suicidality, acting via more proximal depressive symptoms.

Objective
Practice parameters recommend systematic assessment of depression symptoms over the course of treatment to inform treatment planning; however, there are currently no guidelines regarding how to use symptom monitoring to guide treatment decisions for psychotherapy. The current study compared two time points (week 4 and 8) for assessing symptoms during interpersonal psychotherapy for depressed adolescents (IPT-A) and explored four algorithms that use the symptom assessments to select the subsequent treatment.
Method
Forty adolescents (age 12-17) with a depression diagnosis began IPT-A with an initial treatment plan of 12 sessions delivered over 16 weeks. Adolescents were randomized to a week 4 or 8 decision point for considering a change in treatment. Insufficient responders at either time point were randomized a second time to increased frequency of IPT-A (twice per week) or addition of fluoxetine. Measures were administered at baseline and weeks 4, 8, 12, and 16.
Results
The week 4 decision point for assessing response and implementing treatment augmentation for insufficient responders was more efficacious for reducing depression symptoms than the week 8 decision point. There were significant differences between algorithms in depression and psychosocial functioning outcomes.
Conclusion
Therapists implementing IPT-A should routinely monitor depression symptoms and consider augmenting treatment for insufficient responders as early as week 4 of treatment.

Objective
To investigate whether a longitudinal association exists between differential disciplinary parenting practices at age 3 and later child psychopathology at age 11.
Method
Data were obtained from the Millennium Cohort Study (MCS), a UK wide cohort. Discipline style was assessed using a validated maternal reported questionnaire at age 3, for which later outcome data were available. We distinguished between ‘active’ (including smacking, shouting and telling off) and ‘withdrawal’ approaches (including ignoring, removal of privileges and sending to bedroom). Child emotional and behavioral problems were assessed at age 3 and 11 using the maternally completed Strengths and Difficulties Questionnaire (SDQ). The independence of associations between early discipline and later child mental health were investigated using mutually adjusted regression analyses and potential reverse causality was considered by looking at changes between SDQ subscale scores from age 3 to 11.
Results
Differential associations with change in child psychopathology according to discipline type was observed. Both active and withdrawal discipline were associated with a reduction in conduct problems from ages 3 to 11 (active beta cf -0.28, 95% CI -0.34 to -0.21, p<0.001 and withdrawal beta cf -0.19 95% CI -0.24 to -014, p<0.001). However, active approaches were also associated with an increase in emotional problems (beta cf 0.07 95% CI 0.00 to 0.14, p=0.03); not observed for withdrawal approaches.
Conclusion
Different approaches to discipline appear to have differential associations with later child mental health. Further research accounting for a greater number of parent and child characteristics is needed to assess whether such associations are causal.

Objective
To develop and examine the psychometric properties of the Children’s Yale-Brown Obsessive-Compulsive Scale Second Edition (CY-BOCS-II) in children and adolescents with obsessive-compulsive disorder (OCD).
Method
Youth with OCD (N=102; range 7-17 years), who were seeking treatment from one of two specialty OCD treatment centers, participated in the study. The CY-BOCS-II was administered at an initial assessment, and measures of OCD symptom severity, anxiety and depressive symptoms, behavioral and emotional problems, and global functioning were also administered. Inter-rater and test-retest reliability were assessed on a subsample of participants (n= 50 and n= 31, respectively) approximately one week after intial assessment.
Results
The CY-BOCS-II demonstrated moderate-to-strong internal consistency (α = .75-.88) and excellent inter-rater (ICC = .86-.92) and test-retest reliability (ICC = .95-.98) across all scales. Construct validity was supported by strong correlations with clinician-rated measures of OCD symptom severity and moderate correlations with measures of anxiety symptoms. Exploratory factor analysis revealed a two-factor structure, which was generally inconsistent with its adult counterpart, the Yale-Brown Obsessive-Compulsive Scale Second Edition (Y-BOCS-II).
Conclusion
Initial findings support the CY-BOCS-II as a reliable and valid measure of obsessive-compulsive symptoms in youth.

Objective
Caffeine use is common in children and adolescents, but the recommendations for safe consumption are based on decades-old data collected exclusively in adults. Increased availability of caffeine-containing products and a concerted marketing effort aimed at children and adolescents, has increased interest in understanding the physiological, behavioral, and psychological effects of caffeine within this population. This manuscript provides a review of the literature concerning trends and safety of ingested caffeine in children and adolescents.
Method
A search of the National Library of Medicine database was conducted using the terms: caffeine, children, adolescents, and safety in addition to tailored searches on specific topics using combinations of search terms such as energy drinks, cardiovascular, mood, cognitive, mental health, sleep and regulations.
Results
The majority of the literature reviewed here suggests that typical, moderate caffeine consumption in children and adolescents is relatively safe, but higher doses of caffeine consumption (> 400 mg) can cause physiological, psychological, and behavioral harm, in particular in subgroups of children, such as those with psychiatric or cardiac conditions. More attention is being paid to the potential adverse effects of both acute and chronic caffeine use and additional regulations surrounding the sale and marketing of highly caffeinated beverages are now being considered.
Conclusion
More research is needed to fill in gaps in our knowledge, including understanding the relationship between caffeine use and initiation of other substances, such as cigarettes, alcohol, or marijuana, identifying individuals at risk for caffeine toxicity, and developing harm-reduction strategies.

Objective
Based on previous findings that suicidal ideation (SI) and behavior (SB) arose in depressed preschoolers and showed stability into school age, we sought to investigate whether unique clinical and psychosocial correlates of SI/SB and non-suicidal self-injurious behaviors (NSSI) could be identified in young children recuited into a depression treatment study and healthy controls.
Method
Data from n=288 3.0-6.11 year-old children recruited for participation in a psychotherapy treatment study of depression and n=26 healthy control subjects (total N=314) were used. At baseline, subjects received a comprehensive assessment of psychopathology and suicidal ideation/suicidal behavior. Multinominal logistic regressions were conducted comparing those with no SI/SB/NSSI to those with SI/SB or NSSI. Those with SI/SB who also had NSSI were placed in the SI/SB group.
Results
In this sample of young children, the rates of NSSI, SI, and SB were 21.3%, 19.1% and 3.5% respectively. Children with SI/SB or NSSI experienced a greater frequency of violent life events than children with no SI/SB/NSSI. Children with SI/SB had significantly more preoccupation with death compared to subjects with NSSI and subjects with no SI/SB/NSSI. Children with SI/SB had more vegetative signs of depression and greater depression severity and those with NSSI were more irritable with higher depression severity than those with no SI/SB/NSSI.
Conclusion
Distinct characteristics of SI/SB and NSSI in early childhood were identified, informing high risk sub-groups. Findings suggest that clinicians should be aware of the potential for SI/SB and/or NSSI in young children and should directly address these symptoms in clinical interviews.

Objective
We examined racial/ethnic disparities in the receipt of minimally adequate depression treatment among Medicaid-enrolled youth.
Method
We used 2008-2011 Medicaid claims data to derive a cohort of youth (age 5 to 17) that was diagnosed with a new episode of major depression (N=45,816) across nine states. Dichotomous outcomes measured the receipt of: (1) minimally adequate psychotherapy (≥ four psychotherapy visits within 12 weeks of initiation); (2) minimally adequate medication (filled antidepressants for 84 of 144 days); (3) any minimally adequate treatment (psychotherapy or medication); and (4) no psychotherapy or medication. Racial/ethnic disparities were estimated using multivariate logistic regressions that controlled for predisposing, enabling, and need-related factors.
Results
Less than four-tenths (38.3%) of the cohort received minimally adequate psychotherapy, 19.2% received minimally adequate pharmacotherapy, and 49.9% received any minimally adequate treatment; conversely, 16.4% received no treatment. The adjusted percentages of Black (42.3%, p<0.001) and Hispanic (48.2%, p<0.001) youth that received minimally adequate treatment were significantly lower than among non-Hispanic whites (54.7%), due to lower likelihoods of receiving minimally adequate psychotherapy and/or minimally adequate pharmacotherapy. Additionally, the adjusted percentages of Black (20.2%, p<0.001) and Hispanic (15.0%, p<0.01) youth that received no treatment were significantly greater than among non-Hispanic white youth (12.9%).
Conclusion
The percentage of Medicaid-enrolled youth that receive minimally adequate treatment for depression is low overall, and even lower among racial/ethnic minorities than among whites. Future research is needed to identify strategies that improve the overall quality of depression treatment among Medicaid-enrolled youth, as well as reduce disparities in care.

Objectives
Network meta-analyses (NMAs) are gaining traction as the preferred method for evidence synthesis of intervention studies. We aimed to 1) summarize the basics of NMAs; 2) conduct a meta-review of available NMAs on the treatment of child/adolescent psychiatric disorders, appraising their quality.
Method
We systematically searched Pubmed (Medline), PsycInfo, Embase, Ovid Medline, and Web of Knowledge (last update: 9 January 2018). We appraised the quality of each included NMA using the AMSTAR-2 tool and the PRISMA-NMA checklist, which include specific items for NMAs.
Results
We retrieved 18 NMAs (ADHD: 6; psychotic disorders: 4; depression: 2; anxiety disorders: 2; OCD: 1; disruptive behavior disorder: 1, bipolar disorder: 1, plus one NMA on antipsychotics across disorders). Results from the AMSTAR-2 assessment showed that only 27% of the appraised NMAs were rated as moderate; the majority were rated as either low (33%) or critically low quality (40%). Only three of the appraised NMAs reported all of the PRISMA-NMA items specific for NMAs; the network structure was graphically presented in the majority of NMAs (80%), and inconsistency was only described in 47%.
Conclusion
Given the paucity of head-to-head trials in child and adolescent psychiatry, NMAs have the potential to contribute to the field, as they provide evidence-based hierarchies for treatment decision-making, even in the absence of trials directly comparing two or more treatments. However, due to important limitations in the included NMAs, additional methodologically-sound NMAs are needed to inform future guidelines and clinical practice in child and adolescent psychiatry.

Objective
Sex differences in the brain are traditionally treated as binary. We present new evidence that a continuous measure of sex differentiation of the brain can explain sex differences in psychopathology. The degree of sex differentiated brain features (ie, features that are more common in one sex) may predispose individuals toward sex-biased psychopathology and may also be influenced by the genome. We hypothesized that individuals with a female-biased differentiation score would have greater female-biased psychopathology (internalizing symptoms, such as anxiety and depression), whereas individuals with a male-biased differentiation score would have greater male-biased psychopathology (externalizing symptoms, such as disruptive behaviors).
Method
Using the Philadelphia Neurodevelopmental Cohort database acquired from database of Genotypes and Phenotypes, we calculated the sex differentiation measure, a continuous data-driven calculation of each individual’s degree of sex differentiating features extracted from multimodal brain imaging data (Magnetic resonance imaging (MRI) /Diffusion MRI) from the imaged participants (n=866, 407F/459M).
Results
In males, higher differentiation scores were correlated with higher levels of externalizing symptoms (r=0.119, p=0.016). The differentiation measure reached genome-wide association study significance (p<5*10-8) in males with single nucleotide polymorphisms Chromsome5:rs111161632:RASGEF1C and Chromosome19:rs75918199:GEMIN7, and in females with Chromosome2:rs78372132:PARD3B and Chromosome15:rs73442006:HCN4.
Conclusion
The sex differentiation measure provides an initial topography of quantifying male and female brain features. This demonstration that the sex of the human brain can be conceptualized on a continuum has implications for both the presentation of psychopathology and the relation of the brain with genetic variants that may be associated with brain differentiation.

Objective
Callous-unemotional (CU) traits increase risk for children developing severe childhood aggression and Conduct Disorder. CU traits are typically described as highly heritable and debate continues about whether the parenting environment matters in their etiology. Strong genetically-informed designs are needed to test for the presence of environmental links between parenting practices and CU traits. Our objective was to determine whether parental harshness and parental warmth were related to children’s aggression or CU traits when accounting for genetically-mediated effects.
Method
We examined 227 monozygotic twin pairs (454 children) drawn from population-based and at-risk samples of twin families, leading to oversampling of twins living in poverty. We computed multi-informant difference scores combining mother and father reports of their harshness and warmth towards each twin, and differences in mother reports of each twin’s aggression and CU traits.
Results
Twin differences in parental harshness were related to differences in both aggression and CU traits, such that the twin who received harsher parenting had higher aggression and more CU traits. Differences in parental warmth were uniquely related to differences in CU traits, such that the twin receiving warmer parenting evidenced lower CU traits. These effects were not moderated by child sex, age, or family income, with the exception that the relationship between differential parental harshness and differential child aggression was stronger among low-income families.
Conclusion
Parenting is related to child CU traits and aggression, over and above genetically-mediated effects, with low parental warmth being a unique environmental correlate of CU traits.

Objective
Youth with psychiatric disorders distinguished by irritability, including depression and associated trait neuroticism, show deficits in the ability to recognize facial expressions of emotion, particularly happiness. However, the contribution of genetic and environmental factors to this ability remains unknown. The current study examined this trait in twins to assess the genetic and environmental influences on face-emotion recognition abilities and their association with irritability, neuroticism, and depression.
Method
Child and adolescent twins (N = 957 from 496 families), aged 9 to 17 rated their irritability (on the Affective Reactivity Index), neuroticism (on the Junior Eysenck Personality Questionnaire), and depression (on the Short Mood and Feelings Questionnaire) and completed a face-emotion labeling task. Faces depicting anger, disgust, fear, happiness, sadness, and surprise were morphed with a neutral face yielding 10 levels of increasing emotional expressivity. Biometrical twin analyses evaluated contributions of genetic and environmental factors to the etiology of face-emotion recognition and its association with irritability, neuroticism, and depression.
Results
Recognition of each emotion was heritable; common and specific sets of genetic factors influenced all emotions and individual emotions, respectively. Irritability, neuroticism, and depression are modestly, negatively correlated with emotion recognition, particularly the recognition of happiness. For irritability and neuroticism, this correlation appears largely due to genetic factors.
Conclusion
This study maps genetic and environmental contributions to face-emotion recognition and its association with irritability, neuroticism, and depression. Findings implicate common genetic factors in deficits regarding the recognition of happiness associated with irritability and neuroticism in childhood and adolescence.

Objective
Frequent co-occurrence and bidirectional longitudinal associations have led some researchers to question the boundaries between depression and anxiety. A longitudinal investigation of the interconnected symptom structure of these constructs may help determine the extent to which they are distinct, and whether this changes over development. Therefore the present study employed network analysis to examine these symptom-symptom associations developmentally from early childhood to mid-adolescence.
Method
We analysed data from the National Institute of Child Health and Human Development Study of Early Child Care and Youth Development (N = 1,147). Depression and anxiety symptoms were assessed on 7 occasions between ages 5 and 14 years using maternal reports. Weighted, undirected symptom networks were constructed at each time point, and diagnostic boundaries were explored using empirical tests of network modularity (i.e. clustering of symptom nodes). Non-parametric permutation tests were used to determine whether symptoms became more associated over development, and network centrality was examined in order to identify developmental changes in the overall importance of specific symptoms.
Results
Symptoms formed highly interconnected networks, as evidenced by strong associations between depression and anxiety symptoms and a lack of distinct clustering. There was some evidence of an increase in overall connectivity as children aged. Feeling ‘anxious/fearful’ and ‘unhappy/sad’ were consistently the most central symptoms over development.
Conclusion
Minimal clustering of nodes indicated no separation of depression and anxiety symptoms from early childhood through mid-adolescence. An increase in connectivity over development suggests that symptoms may reinforce each other, potentially contributing to the high levels of lifetime continuity of these disorders.

Objective
Although the neural underpinnings of antisocial behavior have been studied extensively, research on pharmacological interventions targeting specific neural mechanisms remains sparse. Hypoactivity of the amygdala and the ventromedial prefrontal cortex (vmPFC) have been reported in antisocial adolescents, which may account for deficits in fear learning (amygdala) and impairments in decision making (vmPFC), respectively. Limited clinical research suggests positive effects of methylphenidate, a dopamine agonist, on antisocial behavior in adolescents. Dopamine is a key neurotransmitter involved in amygdala and vmPFC functioning. The objective of this study is to investigate whether methylphenidate targets dysfunctions in these brain areas in adolescents with antisocial behavior.
Method
A group of 42 clinical referred male adolescents (age 14-17 years) with a Disruptive Behavior Disorder (DBD) performed a fear learning/reversal paradigm in a randomized double-blind placebo-controlled pharmacological fMRI study. DBD participants were randomized to receive either a single dose of 0.3-0.4mg/kg methylphenidate (n=22) or a placebo (n=20), and were compared to 21 matched healthy controls not receiving medication.
Results
In a region of interest analysis of fMRI data during fear learning, the placebo group showed hyporeactivity of the amygdala compared to healthy controls, but amygdala reactivity was normalized in the methylphenidate group. There were no group differences in vmPFC reactivity during fear reversal learning. Whole brain analyses revealed no group differences.
Conclusion
These findings suggest that methylphenidate is a promising pharmacological intervention for youth antisocial behavior which may restore amygdala functioning.

Objective
The serotonin (5-HT) system has long been implicated in autism spectrum disorder (ASD). Whole blood 5-hydroxytryptamine level (WB5-HT) is a stable, heritable biomarker that is elevated in more than 25% of children with ASD. Recent findings indicate that the maternal 5-HT system may influence embryonic neurodevelopment, but maternal WB5-HT has not been examined in relation to ASD phenotypes.
Method
WB5-HT levels were obtained from 181 individuals (aged between 3 and 27 years) diagnosed with ASD, 99 of their fathers, and 119 of their mothers. Standardized assessments were used to evaluate cognitive, behavioral, and language phenotypes.
Results
Exploratory regression analyses found relationships between maternal WB5-HT and nonverbal IQ (NVIQ), Autism Diagnostic Interview-Revised (ADI-R) Nonverbal Communication Algorithm scores, and overall adaptive function on the Vineland Adaptive Behavior Scales-II. Latent class analysis identified a three-class structure in the assessment data, describing children with low, intermediate, and high severity across measures of behavior, cognition, and adaptive function. Mean maternal WB5-HT differed across classes with the lowest maternal WB5-HT levels seen in the highest severity group, (Welch's F(2, 46.048) = 17.394, p < .00001). Paternal and proband WB5-HT did not differ between classes.
Conclusion
Maternal WB5-HT is associated with neurodevelopmental outcomes in offspring with ASD. Prospective, longitudinal studies will be needed to better understand the relationship between the function of the maternal serotonin system during pregnancy in relation to brain development. Further studies in animal models may be able to reveal the mechanisms underlying these findings.

Objective
Exposure to maternal depression during early childhood is a well-documented risk factor for offspring's internalizing problems, but the long-term risk and the psychosocial mechanisms underlying the association remain largely unknown. We examined whether maternal depression during early childhood was associated with offspring internalizing problems in adolescence, and the extent to which negative parenting, peer victimization, and poor friendship quality during middle childhood mediated this association.
Method
We report on a population-based sample of children (n=1443) followed-up from 5 months to 15 years. We use yearly assessments of the exposure variable – maternal depression (5 months-5 years); the putative mediators – peer victimization, friendship quality, and parenting practices (6-12 years); and assessment of the outcome variables at 15 years: self-reported major depressive (MD), generalized anxiety (GA), and social phobia (SP) symptoms. Structural Equation Modeling was used to test mediation by peer and family relationships.
Results
Exposure to maternal depression during early childhood was associated with higher levels of adolescent MD, GA and SP. Peer victimization was the only significant mediator and explained 35.9% of the association with adolescent MD; 22.1% with GA; and 22.1% with SP.
Conclusion
Exposure to maternal depression prior to age 5 years was associated with depression, anxiety, and social phobia extending to adolescence via its impact on peer victimization during middle childhood. Particular attention should be paid to victimization as one potential psychosocial factor via which maternal depression is associated with adolescent internalizing problems.

Objectives
Children with orofacial clefts (OFC) may have an increased risk of poor mental health. This study aimed to investigate the risk of psychiatric diagnoses in individuals with OFC, stratified by cleft type.
Method
A nationwide register-based cohort of all individuals born with non-syndromic OFC in Sweden between 1973 and 2012 (n=7842) was compared to a matched cohort (n=78409) as well as to their unaffected siblings. The risk of psychiatric diagnoses, suicide attempts and suicides was examined by crude and adjusted Cox regression models. Effect modification by sex was investigated with interaction terms in the models.
Results
Children with cleft lip (CL) had a significant higher risk for any psychiatric disorder, intellectual disability and language disorders, children with cleft lip and palate (CLP) had additionally an increased risk for Autism Spectrum Disorder (ASD). Children with cleft palate only (CPO) presented risk increases for the same diagnoses as children with CL and CLP, but with higher hazard ratios, and additionally for psychotic disorders, attention-deficit/hyperactivity disorder (ADHD) and other behavioral or emotional disorders in childhood. Sex stratification indicated higher risk increases among females in CL and CLP but not in CPO. Siblings without OFC were less likely to be diagnosed with any psychiatric disorder, intellectual disability, language disorder, ASD and ADHD compared to their siblings with OFC.
Conclusion
Children with non-syndromic clefts had a significantly higher risk of neurodevelopmental disorders and this risk is unlikely to be explained by familial influences such as inherited genetic or shared environmental factors.

Objective
This study examined variability in autism symptom trajectories in toddlers referred for possible ASD who had frequent observations from 14 to 36 months of age.
Method
A total of 912 observations of the Autism Diagnostic Observation Schedule (ADOS) were obtained from 149 children (103 ASD) followed from age 14 to 36 months. As a follow-up of our previous analysis of ADOS algorithm scores (Lord et al., 2012), we implemented a different analytic approach (Proc Traj) to identify several courses of symptom trajectories using ADOS calibrated severity scores in a larger sample. Proc Traj is a statistical method that clusters individuals into separate groups based on varying growth trajectories. Changes in symptom severity based on individual ADOS items were also examined.
Results
Trajectory analysis of overall symptom severity identified four clusters (Nonspectrum ∼25%; Worsening ∼27%; Moderately-Improving ∼25%; Severe-Persistent ∼23%). Trajectory clusters varied significantly in the proportions of confirmatory ASD diagnosis, the level of baseline and final verbal/nonverbal abilities, and symptom severity. For the Moderately-Improving group, social communication improved whereas restricted and repetitive behaviors (RRB) were stable over time. Language and verbal/nonverbal communication improved for many children, but several social affect and RRB symptoms remained stable or worsened.
Conclusion
Significant variability in symptom trajectories was observed among toddlers referred for possible ASD. Changes in social and RRB domain scores did not always co-occur. Similarly, item level trajectories did not always align with trajectories of overall severity scores. These findings highlight the importance of monitoring individual symptoms within broader symptom domains when conducting repeated assessments for young children suspected of ASD.

Objective
The diagnosis of autism spectrum disorder (ASD) has been found to be remarkably stable but few studies have followed children not initially diagnosed with ASD beyond age 3 to examine late or delayed diagnoses. The current study used a prospective familial-risk design to identify children who had undergone multiple comprehensive assessments in preschool and were determined to be ASD-negative, only to meet criteria for ASD when tested in middle childhood.
Method
Data were pooled across three research teams studying later-born siblings of children with ASD. Fourteen children met inclusion criteria for the Late Diagnosed group and were compared to a large sample of high- and low-risk siblings from the same sites who had ASD or typical development (TD) outcomes at age 3.
Results
As a group, the Late Diagnosed children scored between the TD and ASD groups on most measures administered at age 3 and differed significantly from the ASD group on most measures. However, there was significant heterogeneity among the Late Diagnosed cases. Seven showed very little evidence of ASD in preschool, while seven demonstrated subtle, subthreshold symptomatology.
Conclusion
Some children with ASD may present with a subtle phenotype early in life or show a prolonged time course of symptom development. This emphasizes the need for screening and surveillance schedules that extend past 36 months and continued evaluation of any child who presents with atypical early development and/or high-risk status. The findings also shed light on reasons why the mean age of ASD diagnosis remains over 4 years.

Background
There is a prevailing notion that children with ASD exhibit intense negative and attenuated positive emotions, though the empirical evidence regarding their emotional expressiveness (EE) is limited. Given the importance of emotions in shaping social and cognitive development, we examined intensity and valence of EE and links between EE and autism severity and parent-reported temperament in ASD.
Method
Toddlers (age 21.2 months) with ASD (n=43), developmental delay (DD, n=16) and typical development (TD, n=40) underwent standardized probes designed to induce anger, joy, and fear. Intensity of EE through facial and vocal channels were coded offline. Autism severity and temperament were quantified using the ADOS-2 and ECBQ.
Results
The ASD group exhibited less intense fear compared to both DD and TD groups, more intense anger than DD but not TD, with no differences in joy intensity. All groups showed similar levels of incongruous negative EE. Intensity of fear and anger were not associated with severity of autism symptoms, but lower intensity of joy was related to greater autism severity. Expressed fear and joy were associated with temperament.
Conclusion
The study provides no support for a negative emotionality bias in ASD. Instead, toddlers with ASD display a muted response to threat and an accentuated response to goal-blockage, while the ability to express positive emotions appears intact. Negative emotionality and social disability dimensions are independent. The study demonstrates the complexity of EE in ASD and motivates investigations into underlying mechanisms as well as its role in shaping complex phenotypes of affected children.

ObjectiveAbnormal engagement of the posterior medial frontal cortex (pMFC) occurs during performance monitoring in obsessive-compulsive disorder (OCD), including in pediatric patients. Yet, the development of pMFC function in OCD-affected youth remains poorly understood.MethodSixty-nine patients with pediatric OCD and 72 healthy controls (HC), 8 to 19 years, were scanned during the Multisource Interference Task (MSIT). The effects of group, age, performance and interactions on pMFC response to errors and interference were tested in region of interest ROI) and whole brain analyses. Secondary analyses considered bilateral anterior insula/frontal operculum (aI/fO), given the contribution of these regions with pMFC to a cingulo-opercular network (CON) for task control (e.g., error- and interference-processing).ResultsError-related pMFC activity was greater for OCD than HC, increased with age in OCD, but decreased with age in HC. Greater pMFC activation associated with better performance in HC, but not OCD. In patients, greater pMFC activation to errors associated with lower OCD severity. Altered error-related activation and performance associations were also observed in right aI/fO in OCD, while left aI/fO response to interference associated with lower OCD severity.ConclusionAtypical increase of error-related pMFC activation with age in pediatric OCD suggests altered development of pMFC function during the early course of illness. Greater pMFC activation with better performance in HC, and with age and lower symptom severity in patients suggests an adaptive function of heightened pMFC response to errors that could be further enhanced (e.g., via cognitive training) to improve outcomes in OCD from the early course of illness.

ObjectiveWe examined if a parent-rated general factor of psychopathology in childhood predicted independently measured severe adverse mental health outcomes in adolescence.MethodWe used the Child and Adolescent Twin Study in Sweden, which targets all twin children in Sweden. Parents rated their children (N = 16,806) on 43 symptoms of inattention, hyperactivity-impulsivity, conduct problems, and anxiety/emotionality when the twins turned 12 or 9 years old. Adverse mental health outcomes in adolescence were retrieved from national registers, and included a) psychiatric diagnoses; b) prescription of anxiolytic or antidepressant medication; c) court convictions of crimes; and d) failure to achieve eligibility for high school.ResultsParent-rated inattention, hyperactivity-impulsivity, conduct problems, and anxiety/emotionality in childhood predicted all adverse mental health outcomes in adolescence (mean odds ratio = 1.76; range = 1.41 to 2.18; all ps < .05). However, several of these associations were non-significant in a multiple regression framework, suggesting the influence of common variance. A general factor of psychopathology uniquely predicted all outcomes (mean odds ratio = 1.58; range = 1.34 to 1.84; all ps < .05), whereas the specific factors only predicted a subset of the outcomes.ConclusionMental health problems in childhood are associated with a host of adverse outcomes in adolescence and to a considerable extent these associations are driven by a general factor of psychopathology. The general factor may be important, therefore, to clinical prognosis, which informs clinical decision making for children.

ObjectiveTo determine the percent reduction cutoff on the Multidimensional Anxiety Scale for Children (MASC) that optimally predict treatment response and remission in youth with anxiety disorders.MethodYouths and their parents completed the MASC-C/P pre- and post-treatment, and the Anxiety Disorders Interview Schedule for DSM-IV–Child and Parent Versions (ADIS-IV-C/P) and Clinical Global Impression – Improvement scale (CGI-I) were administered by independent evaluators. Treatment response and remission were defined by posttreatment ratings on the CGI-I and the ADIS-IV-C/P, respectively. Quality receiver operating characteristic methods determined the optimal cutoff on the MASC-P for predicting overall remission (loss of all study entry diagnoses), and optimal percent reductions on the MASC-P for predicting treatment response and remission of separation anxiety, social anxiety and generalized anxiety.ResultsA posttreatment raw score of 42 optimally predicted remission. A reduction of 35% on the total MASC-P predicted treatment response. A reduction of 30% on the Separation Anxiety/Panic subscale of the MASC-P predicted separation anxiety remission. A reduction of 35% on the Social Anxiety subscale of the MASC-P predicted social anxiety remission. The MASC did not evidence a cutoff for remission of Generalized Anxiety Disorder.ConclusionMASC cutoffs can facilitate comparison across studies and guide practice, aiding clinicians in assessing progress and informing treatment plans.

ObjectiveAlthough chronic irritability in childhood is prevalent, impairing, and predictive of later maladjustment, its pathophysiology is largely unknown. Deficits in reward processing are hypothesized to play a role in irritability. The current study aimed to identify how the developmental timing of irritability during preschool and school-age relates to reward-related brain function during school-age.MethodChildren’s irritability was assessed during the preschool period (Wave 1; ages 3.0-5.9 years) and three years later (Wave 2; ages 5.9-9.6 years) using a clinical interview. At Wave 2, children (N=46; 28 females) performed a monetary incentive delay task in which they received rewards, if they successfully hit a target, or no reward regardless of performance, during fMRI acquisition.ResultsChildren with more vs. less severe preschool irritability, controlling for concurrent irritability, exhibited altered reward-related connectivity: right amygdala with insula and inferior parietal lobe as well as left ventral striatum with lingual gyrus, post-central gyrus, superior parietal lobe and culmen. Children with more vs. less severe concurrent irritability, controlling for preschool irritability, exhibited a similar pattern of altered connectivity between left and right amygdalae and superior frontal gyrus and between left ventral striatum and precuneus and culmen. Neural differences associated with irritability were most evident between reward and no reward conditions when participants missed the target.ConclusionPreschool irritability and concurrent irritability were uniquely associated with aberrant patterns of reward-related connectivity, highlighting the importance of developmental timing of irritability for brain function.

ObjectiveThis study examined cross-informant evidence for a general factor of psychopathology (“P”), and a narrower, clinically-oriented dysregulation general factor based on the Dysregulation Profile (“DP”) in a large clinical sample of children and adolescents. We also compared the magnitude of P and DP general factor associations with self-harm and suicidal ideation as an indicator of criterion validity.MethodItem-wise data from the Child Behavior Checklist (N = 2,934; ages 4-18) were analyzed using confirmatory bifactor modeling and replicated in a supplementary analysis using Youth Self Report data (N = 2,395).ResultsGeneral P and DP bifactor models fit the data better than single-factor and correlated factor models. Cross-informant criterion analyses on a subset of youth (n = 1,552) suggested that whether modeled as latent P or DP, associations with a brief composite index of self-harm and suicidal ideation are essentially of the same magnitude.ConclusionOur findings provide novel, large-sample support for the existence of general factors of psychopathology and dysregulation in clinically referred children and adolescents using a standardized rating system of psychopathology symptoms. Moreover, our results provide preliminary evidence that general psychopathology and dysregulation factors are clinically meaningful constructs. In addition, our findings raise the possibility that the DP general factor may serve as an efficient proxy for the general psychopathology factor in future clinical applications. Further efforts are necessary to understand the core empirical meaning of the P factor and to determine how it can be applied to clinical assessment and intervention.

ObjectiveWhile early and accurate screening is required for the remediation of Attention-Deficit/Hyperactivity Disorder (ADHD), possible gender differences have not been extensively studied. We examined the classification accuracy of the parent and preschool teacher version of the Strengths and Difficulties Questionnaire (SDQ) hyperactivity-inattention (HI) subscale in girls and boys.MethodThe study was part of the Norwegian Mother and Child Cohort Study (MoBa). Parents and preschool teachers rated a total of 238 girls and 276 boys (mean age 3 ½ years) with the SDQ HI subscale. Blinded to the parent and teacher ratings, interviewers classified the children by ADHD diagnoses with the Preschool Age Psychiatric Assessment Interview.ResultsAreas under the curves for the parent HI subscale scores were good for both girls and boys (.87 and .80, respectively). Preschool teacher classifications were fair (.76) for girls and poor (.62) for boys, a significant difference (p = .017). The subscale accurately identified children without ADHD at low parent scores (≤4), and fairly accurately identified ADHD at high scores (≥9) with maximum probabilities of finding true cases were .75 in girls and .55 in boys. Intermediate scores gave the best balance between sensitivity and specificity with low probabilities of correctly identifying children with ADHD.ConclusionThe parental SDQ HI subscale was useful for screening for ADHD in preschool girls and boys. For preschool teachers, the subscale was useful for screening girls.